- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.58 / $3,089.70 / $5,440.99
| Facility | | $1,355.58 | $3,089.70 | $5,440.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.90 / $1,165.93 / $1,651.73
| Professional | | $1,029.90 | $1,165.93 | $1,651.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.40 / $1,148.40 / $3,484.68
| Professional | | $1,148.40 | $1,148.40 | $3,484.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Professional | | $3,500.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.08 / $2,728.27 / $6,786.83
| Facility | | $1,263.08 | $2,728.27 | $6,786.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.64 / $9,366.27 / $9,366.27
| Professional | | $2,366.64 | $9,366.27 | $9,366.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,331.85 / $4,372.22
| Facility | | $294.00 | $2,331.85 | $4,372.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.37 / $2,565.04 / $4,216.77
| Professional | | $2,040.37 | $2,565.04 | $4,216.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.73 / $1,943.21 / $3,523.61
| Professional | | $1,651.73 | $1,943.21 | $3,523.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,728.27 / $6,995.00
| Facility | | $597.00 | $2,728.27 | $6,995.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.08 / $2,118.10 / $4,469.38
| Professional | | $1,263.08 | $2,118.10 | $4,469.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.15 / $1,165.93 / $3,050.55
| Professional | | $816.15 | $1,165.93 | $3,050.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.21 / $2,234.64 / $2,234.64
| Facility | | $1,943.21 | $2,234.64 | $2,234.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.73 / $1,943.21 / $2,335.58
| Professional | | $1,651.73 | $1,943.21 | $2,335.58 |